Stick on devices using peripheral defocus to treat progressive refractive error

ABSTRACT

An apparatus to treat refractive error of an eye comprises an optic comprising an optical zone and a peripheral defocus optical structure to form images of a plurality of stimuli anterior or posterior to a peripheral portion of a retina of the eye. In some embodiments, the peripheral defocus optical structure located outside the optical zone. In some embodiments, the peripheral defocus optical structure comprises optical power to focus light to a different depth of the eye than the optical zone. In some embodiments, the optic comprises one or more of a lens, an optically transparent substrate, a beam splitter, a prism, or an optically transmissive support.

RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.17/304,630, filed Jun. 23, 2021, which is a continuation ofInternational Patent Application No. PCT/US2021/036102, filed Jun. 7,2021, published as WO 2021/252320 on Dec. 16, 2021, which applicationclaims the benefit under 35 U.S.C. § 119(e) of U.S. Provisional PatentApplication No. 63/036,234, filed Jun. 8, 2020, which are incorporated,in their entirety, by this reference.

The subject matter of the present application is related toPCT/US2019/043692, filed on Jul. 26, 2019, published as WO 2020/028177on Feb. 6, 2020, the entire disclosure of which is incorporated hereinby reference.

BACKGROUND

Prior approaches to treating refractive error such as myopia can be lessthan ideal in at least some respects. Spectacle lenses, contact lenses,and refractive surgery can be used to treat refractive errors of theeye. However, lenses must be worn in order to correct the errors, anduncorrected refractive error can impact a person's ability to achieveand fully participate in school, sports, and other activities. Althoughsurgery can be performed to decrease refractive error, and surgery comeswith risks, such as infection and degraded vision in at least someinstances. Also, these approaches do not address the underlying changesin the length of the eye that is related to refractive error such asmyopia.

Work in relation to the present disclosure suggests that the retina ofmany species, including human beings, responds to defocused images andis repositioned through scleral remodeling, in order to decrease theblur caused by the defocus. The mechanism of the generation of thegrowth signal is still under study, but one observable phenomenon is anincrease in thickness of the choroid. A defocused image can cause thechoroid thickness to change, which is related to the axial length of theeye. Changes to the axial length of the eye can alter the refractiveerror by changing the position of the retina in relation to the cornea.For example, an increase axial length increase myopia of an eye byincreasing the distance between the cornea and lens.

While the defocus of images can play a role in choroidal thickness andchanges in the axial length of the eye, the prior approaches are lessthan ideally suited to address to refractive error of the eye related toaxial length. Although pharmaceutical treatments have been proposed totreat myopia associated with axial length growth, these treatments canhave less than ideal results and have not been shown to safely treatrefractive error at least some instances. Although light has beenproposed as a stimulus to alter the growth of the eye, at least some ofthe prior devices can provide less than ideal results. Also, the time oftreatment can be longer than would be ideal, and at least some of theprior approaches may be more complex than would be ideal.

Therefore, new approaches are needed to treat refractive error of theeye that ameliorate at least some of the above limitations of the priorapproaches.

SUMMARY

An apparatus to treat refractive error of an eye comprises an opticcomprising an optical zone and a peripheral defocus optical structure toform images of a plurality of stimuli anterior or posterior to aperipheral portion of a retina of the eye. In some embodiments, theperipheral defocus optical structure located outside the optical zone.In some embodiments, the peripheral defocus optical structure comprisesoptical power to focus light to a different depth of the eye than theoptical zone. In some embodiments, the optic comprises one or more of alens, an optically transparent substrate, a beam splitter, a prism, oran optically transmissive support.

INCORPORATION BY REFERENCE

All patents, applications, and publications referred to and identifiedherein are hereby incorporated by reference in their entirety and shallbe considered fully incorporated by reference even though referred toelsewhere in the application.

BRIEF DESCRIPTION OF THE DRAWINGS

A better understanding of the features, advantages and principles of thepresent disclosure will be obtained by reference to the followingdetailed description that sets forth illustrative embodiments, and theaccompanying drawings of which:

FIG. 1 shows a side view of a vision apparatus to treat refractive errorof an eye, in accordance with some embodiments;

FIG. 2 shows an apparatus to treat refractive error of an eye, inaccordance with some embodiments;

FIG. 3A shows the apparatus of FIG. 2 in use, in accordance with someembodiments;

FIG. 3B shows a display with a plurality of stimuli and thecorresponding dimensions of the defocused stimuli on the retina indegrees, in accordance with some embodiments;

FIG. 4 shows a cross-sectional perspective view of the apparatus of FIG.2, in accordance with some embodiments;

FIG. 5 shows assembly of the apparatus of FIG. 2 onto a lens, inaccordance with some embodiments;

FIG. 6 shows an apparatus to treat refractive error of an eye, inaccordance with some embodiments;

FIG. 7 shows the apparatus of FIG. 6 in use, in accordance with someembodiments;

FIG. 8 shows a perspective view of the apparatus of FIG. 6, inaccordance with some embodiments;

FIG. 9 shows a cross-sectional perspective view of the apparatus of FIG.6, in accordance with some embodiments;

FIG. 10 shows assembly of the apparatus of FIG. 6 onto a lens, inaccordance with some embodiments;

FIG. 11 shows an apparatus to treat refractive error of an eye, inaccordance with some embodiments;

FIG. 12 shows the apparatus of FIG. 11 in use, in accordance with someembodiments;

FIG. 13 shows a perspective view of the apparatus of FIG. 11, inaccordance with some embodiments;

FIG. 14 shows a cross-sectional perspective view of the apparatus ofFIG. 11, in accordance with some embodiments;

FIG. 15 shows assembly of the apparatus of FIG. 11 onto a lens, inaccordance with some embodiments;

FIG. 16 shows an apparatus to treat refractive error of an eye, inaccordance with some embodiments;

FIG. 17 shows an apparatus comprising a device coupled to a display of auser device to provide retinal stimulation to the user;

FIG. 18 shows a plurality of lenslets with a liquid crystal materialbetween electrodes; and

FIG. 19 shows a treatment apparatus comprising a display coupled to alenslet array, in accordance with some embodiments.

DETAILED DESCRIPTION

The following detailed description and provides a better understandingof the features and advantages of the inventions described in thepresent disclosure in accordance with the embodiments disclosed herein.Although the detailed description includes many specific embodiments,these are provided by way of example only and should not be construed aslimiting the scope of the inventions disclosed herein.

The presently disclosed methods and apparatus can be configured in manyways to provide retinal stimulation as described herein. The presentlydisclosed methods and apparatus are well suited for combination withmany prior devices such as, one or more of an ophthalmic device, a TVscreen, a computer screen, a virtual reality (“VR”) display, anaugmented reality (“AR”) display, a handheld, a mobile computing device,a tablet computing device, a smart phone, a wearable device, a spectaclelens frame, a spectacle lens, a near eye display, a head-mounteddisplay, a goggle, a contact lens, an implantable device, a cornealonlay, a corneal inlay, a corneal prosthesis, or an intraocular lens.Although specific reference is made to spectacles and contact lenses,the presently disclosed methods and apparatus are well suited for usewith any of the aforementioned devices, and a person of ordinary skillin the art will readily appreciate how one or more of the presentlydisclosed components can be interchanged among devices, based on theteachings provided herein.

Although the presently disclosed methods and apparatus can be used totreat many types of refractive error, the presently disclosed methodsand apparatus are well suited to treat the progression of myopia, forexample.

FIG. 1 shows a cross section of an apparatus 100 to treat refractiveerror of an eye. The apparatus 100 may comprise any suitable visiondevice, such as a VR headset. The components of the apparatus may bearranged with reference to the eye of a user. The apparatus 100 such asa VR headset may comprise a display 110. The display 110 provides visualcontent, such as video games and movies for viewing by a user. Theimages of the display 110 are transmitted through the optic 112 to theeye of the user, represented by the cornea 114 and the pupil 116. Theoptic 112 may comprise a refractive lens that changes the focus of thelight before the light enters the eye of a user. Alternatively, theoptic may comprise flat surfaces, such as a beam splitter, or a prismfor example. The optic 112 may include a posterior optical structure 122that may be curved or otherwise shaped to adjust the focus of theprojected image from the display 110 onto the user's eye. For example,in apparatus 100 such as a VR device, the posterior optical structure122 may comprise a Fresnel lens. In other devices, for example inspectacles, the optic 112 may comprise a prescription lens to correctrefractive errors of the patient's eye with the posterior opticalsurface 122 shaped to correct one or more of myopia, hyperopia,astigmatism, and other refractive errors of the eye. Although referenceis made to a Fresnel lens, the lens may comprise any suitable lensstructure, such as one or more of a curved lens, a toric lens, a Fresnellens, a diffractive, or a holographic element, and combinations thereof.

A defocus treatment device 124 may be attached or part of a surface ofthe optic 112. For example, in FIG. 1 the defocus treatment device 124is a part of, or attached to, the front surface of the optic 112. Insome embodiments, the treatment device 124 is adhered to the optic 112with an adhesive. In some embodiments, the defocus treatment device 124comprises a peripheral defocus optical structure 120 arranged around acentral optical zone 118. In some embodiments, the central optical zoneis configured to provide a clear field of view of an object such as thedisplay 110. The optical zone can be configured in many ways, and maycomprise an optical zone with correction to provide the eye with anunobstructed in focus image of the display on the macula of the retinaof the eye. In some embodiments, the defocus optical structure 120alters the focus of the light. The defocus optical structure can beconfigured to form an image of a stimulus anterior to the retina totreat refractive error of the eye such as myopia. Alternatively, theimage of the stimulus can be formed posterior to the retina of the eye.The image of the stimulus may comprise an image of a stimulus on thedisplay, for example. Although reference is made to the treatmentdefocus device adhered to the lens 112, in some embodiments the defocusoptical structure 120 is formed directly on the surface of lens 112, forexample with structures etched into the surface of lens 112.

The dimensions of the optical zone 118 and peripheral defocus opticalstructure 120 zone can be configured in many ways. In some embodiments,the peripheral defocus optical structure 120 is sized and shaped totransmit light at an angle within a range from 12 degrees to 40 degreeswith reference to an entrance pupil of the eye or within a range from 15to 35 degrees, for example. In some embodiments, the angle comprises ahalf-angle, such as an angle between the boundary of the optical zoneand a line formed through the center of the optical zone and the centerof the entrance pupil. In some embodiments, the peripheral defocusoptical structure 120 is sized to be at an angle within range from 15degrees to 50 degrees with reference to an entrance pupil of the eye,for example. In some embodiments, the peripheral defocus opticalstructure 120 comprises an inner boundary and an outer boundary. Theinner boundary corresponding to an inner boundary angle 125 within arange from 15 degrees to 20 degrees with reference to the entrance pupil116 of the eye and the outer boundary corresponding to an outer boundaryangle 126 within a range from 25 degrees to 70 degrees with reference tothe entrance pupil of the eye. In some embodiments, the lens is adistance from the eye. The distance, the inner boundary, and the outerboundary may be dimensioned to provide the inner angle and the outerangle with reference to the entrance pupil of the eye.

The peripheral defocus optical structure 120 may be annular in shape,having an inner diameter and an outer diameter selected such that theperipheral defocus is applied to a portion of the retina of thepatient's eye that is eccentric to the fovea. For example, the innerdiameter may be at an angle of about 7.5 degrees with respect to anoptical axis of the optic 112 and pupil, this angle may be referred toas an inner boundary angle 125. The outer diameter of the peripheraldefocus optical structure 120 may be at an outer boundary angle 126 withrespect to the optical axis of the primary eye and the people, forexample at 17.5 degrees. Such an arrangement, results in the peripheraldefocus optical structure 120 being located in a peripheral field ofview of the user with a corresponding defocus of the projected light ina peripheral region of the user's retina eccentric to the fovea.

Although reference is made to an annular shape, the peripheral defocusoptical structure 120 can be configured with other shapes, such aspolygons, squares, triangles, and may comprise a plurality of discreteoptical structures located around the optical zone at appropriatelocations.

In some embodiments, the peripheral defocus optical structure 120 mayinclude optics or optical structures that change the focus of theprojected light in the patient's eye. Peripheral defocus opticalstructure 120 may comprise one or more of diffractive optics, lenslets,gradient index (“GRIN”) lenslets, crossed cylindrical rods, masks, orechelettes that alter the focus of light passing through the defocusoptical structure 120.

In some embodiments, the peripheral defocus optical structure 120 isdimensioned to provide defocused images to a peripheral portion of theretina. In some embodiments, the defocus optical structure 120 isconfigured to provide a stimulus to a peripheral portion of the retinathat comprises a region of the retina outside the fovea or the macula,so as to provide clear vision to the fovea and the macula when the userlooks ahead and the peripheral defocus optical structure 120 provides adefocused image onto the peripheral retina. The image may be defocusedin a range between 2.0 to 6.0 Diopters (“D”) myopically or hyperopicallywith respect to the retina. For example, the defocus may be 3.5 to 5 Danterior to the retina, e.g. myopic defocus, or posterior to the retina,e.g. hyperopic defocus. The defocus is preferably between 2.5 to 5.0 D,and more preferably between 3.0 to 5.0 D.

In some embodiments, a defocus treatment device may be used incombination with localized stimuli projected by a display into theperipheral zone to treat refractive errors of the eye. In the defocustreatment device 124, the stimuli along with the video content projectedby a display, are projected through the peripheral defocus opticalstructure 120 and accordingly both the image of the video content andthe stimuli are defocused by the peripheral defocus optical structure.

For the treatment of spherical refractive errors of the eye, such asmyopia, the stimulation projected to the retina may be uniform about theperiphery of the central optical zone 118. For the treatment ofcylindrical refractive errors of the eye, such as astigmatism, thestimulation projected to the retina may be non-uniform about theperiphery of the central optical zone 118. For example, the stimulationmay be greater along a meridian corresponding to or aligned with anastigmatic first axis of the eye and symmetrically mirrored about asecond astigmatic axis of the eye.

FIG. 2 depicts a defocus treatment device 124 with a hardware-baseddefocus structure and stimuli provided by software, such as softwarethat modifies the image projected from the display such that the imageincludes appropriate stimuli. The defocus treatment device 124 includesa central optical zone 118 and a peripheral defocus optical structure120. The central optical zone 118 may be plano such that it hassubstantially planar surfaces or may otherwise be shaped such that itprovides little to no change in the angle of the incident light passingthrough the central optical zone 118. Although reference is made to thecentral optical zone comprising substantially planar surfaces, thecentral optical zone my comprise optical power to correct refractiveerror of the eye, or combined with optical correction such asspectacles. The central optical zone 118 may also include a filter 130such as a neutral density filter or mask.

In some embodiments, the neutral density filter is provided in order toincrease the intensity of the stimuli in relation to the central clearvision zone, so as to provide increased stimulation to the outerportions of the retina, e.g. the peripheral retina. In some embodiments,a neutral density filter comprises a filter that substantially equallyreduces or modifies the intensity of light in the visible wavelengthswithout inducing changes in the hue or color of the light passingthrough the filter. The neutral density filter may reduce theillumination of the light by 80% to 99%, preferably between 90 and 95%,more preferably about 97%. The neutral density filter 130 may provide adifference in illumination between the central optical zone 118 or otherfiltered areas and the outer zone or other non-filtered areas of atleast a factor of 5, preferably at least a factor of 10, 20, or 30. Insome embodiments, the illumination difference provided by the neutraldensity filter and non-filtered areas of the defocus treatment device124 may be a factor of about 5, 10, 20, or 30. In some embodiments theillumination difference may be between a factor of 5 and 30, morepreferably between a factor of 10 and 20. Although reference is made toa neutral density filter, in some embodiments the filter 130 comprises atinted filter.

In some embodiments, the outer area of the defocus treatment device 124includes a peripheral defocus optical structure 120. The peripheraldefocus optical structure 120 may be provided by a Fresnel lens as shownin FIGS. 2, 3A, 3B, 4, and 5, or any suitable optical structure asdescribed herein. The Fresnel lens is dimensioned to provide defocusedimages to a peripheral portion of the retina. In some embodiments, theperipheral portion of the retina comprises a region of the retinaoutside the fovea or the macula, and defocus is provided to this areawhile the central area is not defocused so as to provide clear vision tothe fovea and the macula when the user looks ahead. The Fresnel lens ofthe defocus optical structure 120 may have an optical power within arange from 2.0 D to 6.0 D myopically or hyperopically. For example, theoptical power may be within a range from 3.5 D to 5 D myopically orhyperopically. In some embodiments, the optical power is preferablywithin a range from 2.5 D to 5.0 D, and more preferably within a rangefrom 3.0 D to 5.0 D.

The peripheral defocus optical structure 120 may be annular in shapehaving an inner diameter and an outer diameter selected such that theperipheral defocus is applied to a portion of the retina of thepatient's eye that is eccentric to the fovea. For example, the innerdiameter may be selected such that it is at an angle of about 7.5degrees with respect to an optical axis of the optic 112 and pupil. Theouter diameter of the peripheral defocus optical structure 120 may be atan outer boundary angle with respect to the optical axis of the primaryeye and the people, for example at 17.5 degrees. Such an arrangementresults in the peripheral defocus optical structure 120 being located ina peripheral field of view of the user with a corresponding defocus ofthe projected light in a peripheral region of the user's retinaeccentric to the fovea.

In some embodiments, a defocus treatment device may be used incombination with localized stimuli in the peripheral zone to treatrefractive errors of the eye. The localized stimuli may be part of aprojected image, for example from a display, or may be provided bystructure within or a part of the defocus treatment device.

For example, FIG. 3A depicts defocus treatment device 124 in front of adisplay 110. The display 110 may provide video or other image contentfor projection through the defocus treatment device 124 and into the eyeof a user. As discussed above, the defocus treatment device 124 may beplaced anterior to the optic 112, such as a lens of a virtual realityheadset or eyeglasses or other devices worn by user.

FIG. 3B shows the display 110 with a plurality of stimuli and thecorresponding dimensions of the defocused stimuli on the retina indegrees. The size of the stimuli on the display is related to thedistance between the user and the display, and the dimensions can bechanged in accordance with the viewing distance to provide anappropriate angular subtense to the retina. One of ordinary skill in theart can readily perform calculations to determine the size of andlocations of the stimuli on the display to provide appropriate angularsizing of the defocused projected images. Each of the stimuli comprisesa distance across corresponding to an angular illumination on theretina, for example 3.3 degrees. The stimuli are arranged to provide aclear central field of view, which can be 15 degrees, for example. Theplurality of stimuli comprises a maximum distance across, e.g. 70 mm,which corresponds to an angular subtense of 35 degrees.

In the embodiments shown in FIGS. 3A and 3B, the video content or otherimagery provided by the display 110 may be modified to include stimuli136. The stimuli 136 may be provided in the form of increased luminosityor brightness at locations eccentric to the center of the image on thedisplay. The stimuli 136 can be positioned on the display 110 to providestimulation to peripheral regions of the retina when passed through thedefocus optical structure 120. In some embodiments, a processor isconfigured with instructions to place the stimuli 136 at locations onthe display corresponding to locations on the retina. The display 110can be located at an appropriate distance from the defocus opticalstructure 120 so as to form image the stimuli 136 anterior or posteriorto the retina as described herein.

The stimuli may be located in fixed locations or within a range from thecenter of the display 110. In some embodiments, such a spatialarrangement of stimuli within the display may provide stimulation insubstantially fixed locations on the retina of a user because thedisplay, the defocus treatment device, in the user's eyes are maintainedin a substantially fixed arrangement by the mounting of the headset tothe patient's head, e.g. with a VR or AR headset. In some embodiments,the headset may include an eye tracker that tracks the location and/orthe orientation of the user's eye. The location of the stimuli on thedisplay may be updated based on the location and/or the orientation ofthe user's eye. In some embodiments, the peripheral stimuli may beturned on or off based on the position of the user's eye. For example,in some embodiments, the user's eye may be at a point of regard suchthat the stimuli might appear within the user's central vision. In suchembodiments, stimuli that would otherwise appear within the user'scentral vision may be deactivated when the eye tracker detects that thestimulation might be within the user's central vision.

The stimuli may be sized such that they are about 0.5 to 5 degrees inapparent diameter in the field of view of a user, more preferably about2 to 3 degrees, and most preferably about 2.3 degrees.

The one or more stimuli may include images configured in many ways andmay include an image structure corresponding to information or contentassociated with spatial frequencies. In some embodiments, the one ormore images projected in the stimuli comprises a spatial frequencywithin a range from 1 cycle per degree to 180 cycles per degree, and acontrast within a range 99.9% to 2.5%, for example. In some embodiments,the projected image comprises image structure content configured toprovide a range of spatial frequencies, for example within a range from2 cycles per degree to about 60 cycles per degree. In some embodiments,the image is projected onto the retina with a modulus of an opticaltransfer function that is equal to or better than 0.3 at a spatialfrequency of 50 lp/mm or greater.

In some embodiments, the stimuli may include a darker area within abrighter area or a brighter area within a darker area. For example, asshown in FIGS. 3A and 3B, each of the plurality of stimuli may include abright circular area with a dark cross shape inscribed within. The crossshape may include two dark lines intersecting perpendicular to eachother, for example, at their midpoints and at the center of the brightcircle. In some embodiments, the stimuli may include a single lineextending across the diameter of the circle.

In the defocus treatment device 124, the stimuli 136 along with thevideo content projected by the display 110 are projected through theperipheral defocus optical structure 120 and accordingly both the imageof the video content and the stimuli 136 are defocused by the peripheraldefocus optical structure 120.

FIG. 4 shows a cross-section of defocus treatment device 124, includingthe plano center area 118 and the peripheral defocus optical structure120. As shown in FIG. 4 the peripheral defocus optical structure 120 maybe a Fresnel lens or other suitable optical structure with a firstcurved surface having a shape according to the desired diopter of thelens and a second surface that may be slanted with respect to theoptical axis of the lens, as shown in FIG. 4, or may be perpendicular tothe optical axis of the lens. The peripheral defocus optical structurefor may have other shapes or structures. For example, the peripheraldefocus optical structure may be a diffractive optical structure, anechelette, or a series of concentric annular lenses having a curvedsurface of the desired diopter.

As further shown in FIG. 4, the defocus treatment device 124 may includeone or more of filter 130 or a filter or mask layer 142. In someembodiments, the layer 142 comprise a neutral density layer, althoughthe layer may be tinted or clear, for example. The neutral density layer142 may include a neutral density filter in the areas of the lens thatare desired to be darker and have lower illumination. The neutraldensity filter may be located on a posterior surface of the defocustreatment device 124 opposite an anterior surface on which theperipheral defocus optical structure 120 is located. The neutral densityfilter layer 142 may be located about the plano center optical zone 118such that light passing through the plano center optical zone 118 alsopasses through the neutral density filter. In some embodiments, theneutral density filter layer 142 may extend about the peripheral defocusoptical structure 120 such that a portion of the light passing throughthe peripheral defocus optical structure 120 is filtered by the neutraldensity filter layer 142. As further shown in FIG. 4, peripheral stimulimay be provided, at least in part, by one or more locations on thedefocus treatment device 124 not subject to filtering by the neutraldensity filter layer 142. Structures 410 may be formed in or through theneutral density filter layer 142 to allow unfiltered light to passthrough. For example, in FIG. 4 the defocus treatment device 124includes a neutral density filter layer 142 and stimuli locations withstructures 410 formed to allow unfiltered light to pass through. Thestructures 410 may be of any suitable shape as described herein, forexample so as to form a bright circular area with a dark cross shapeinscribed within. The structures 410 may comprise one or more of atransparent material, or apertures for example. The cross shape mayinclude two dark elongated structures formed by the neutral densityfilter that intersect perpendicular to each other at their midpoints andat the center of the circle. In some embodiments, the stimuli mayinclude a single line formed by the neutral density filter layer 142that extends across the diameter of the circle. Although reference ismade to a cross shape, the structures 410 may comprise any suitableshape to provide a stimulus as described herein.

In some embodiments, neutral density filter 130 may extend beyond thecentral plano region of the defocus treatment device 124. For example,the neutral density filter 130 may extend to encompass the peripheraldefocus optical structure 120. In some embodiments, the region of thedefocus treatment device 124 that includes the peripheral defocusoptical structure 120 may include portions masked by the neutral densityfilter 130 and portions not masked by the neutral density filter 130.The unmasked or clear portions of the outer area may be clear andoptically aligned with stimuli provided in the image or video content ofthe display 110. When optically aligned, the unmasked portions of theouter area and the stimuli appear superimposed over each other from theperspective of the user. By combining increased luminosity from thestimuli in the projected image with the difference in luminosity ofmasked and unmasked regions of the defocus treatment device, a greaterdifference between the luminosity of the stimuli as compared tonon-stimulated regions may be provided.

With reference to FIG. 4 and FIG. 5, the defocus treatment device 124may include a clear base 140 on a posterior side of the defocustreatment device 124. The base 140 may include a lens interface surface144 for coupling the defocus treatment device 124 to a lens, such aslens 112. In some embodiments, the lens interface surface 144 mayinclude an adhesive to further facilitate coupling the defocus treatmentdevice 124 to a lens or other structure. In some embodiments, thedefocus treatment device 124 may be formed directly on or in a lens. Insuch embodiments, the defocus treatment device 124 may not have a base140 on an anterior surface or the base 140 may be the optical structuresuch as the lens 112.

FIG. 6 depicts a defocus treatment device 124 with a hardware-baseddefocus structure and stimuli provided by hardware and optionally bysoftware, such as software that modifies the image projected from adisplay to include stimuli. The defocus treatment device 124 includes acentral optical zone 118. The central optical zone 118 may be plano suchthat it has substantially planar surfaces or may otherwise be shapedsuch that it provides little to no change in the angle of the incidentlight passing through the central optical zone 118. The central opticalzone 118 may also include a neutral density filter 130 or mask 150. Thedefocus treatment device 124 may have a substantially plano anteriorsurface in non-stimuli areas, for example in areas not includinglenslets 146.

The defocus treatment device 124 may also include a neutral densityfilter 130. The neutral density filter 130 filters light passing throughthe plano regions of the defocus treatment device 124. In someembodiments, the neutral density filter 130 filters light passingthrough the defocus treatment device 124 in non-stimulated regions ofthe defocus treatment device 124.

The outer area of the defocus treatment device 124 includes a peripheraldefocus optical structure 120. The peripheral defocus optical structure120 may include one or more lenses in the outer region of the device124. For example, the peripheral defocus optical structure 124 mayinclude an array of lenslets 146, as shown in FIGS. 6, 7, 8, 9 and 10.The plurality of lenslets 146 may be shaped and arranged to providedefocused images to a peripheral portion of the retina while providingclear vision to the fovea and the macula when the user looks ahead. Theeach lenslet 146 of the defocus optical structure 120 may have anoptical power within a range a range from 2.0 D to 6.0 D myopically orhyperopically. For example, the optical power may be within a range from3.5 D to 5 D myopically or hyperopically. The curvature is preferablybetween 2.5 to 5.0 D, and more preferably between 3.0 to 5.0 D.

The lenslets 146 of the peripheral defocus optical structure 120 may bearranged in one or more circular arrays centered about the centraloptical zone 118 of the defocus treatment device 124. The one or morecircular arrays may form an annular shape having an inner diameter andan outer diameter selected such that the peripheral defocus is appliedto a portion of the retina of the patient's eye that is eccentric to thefovea. For example, the inner diameter may be selected such that it isat an angle of about 7.5 degrees with respect to an optical axis of theoptic 112 and pupil. The outer diameter of the peripheral defocusoptical structure 120 may be at an outer boundary angle with respect tothe optical axis of the primary eye and the people, for example at 17.5degrees.

In some embodiments, the location of the lenslets 146 and the unfilteredareas of the defocus treatment device 124 may be positioned with respectto each other such that the light passing through the unfiltered areasof the device 124 also pass through the lenslets 146 such that theunfiltered light is defocused with respect to the patient's retina. Adefocus treatment device may be used in combination with localizedstimuli in the peripheral zone to treat refractive errors of the eye.The localized stimuli may be part of a projected image, for example froma display, or may be provided by structure within or a part of thedefocus treatment device.

For example, FIG. 7 depicts defocus treatment device 124 in front of adisplay 110. The display 110 may provide video or other image contentfor projection through the defocus treatment device 124 and into the eyeof a user. As discussed above, the defocus treatment device 124 may beplaced anterior to the optic 112, such as a lens of a virtual realityheadset or eyeglasses or other devices worn by user. In the embodimentshown in FIG. 7 the video content or other imagery provided by thedisplay 110 may be modified to include stimuli 136. The stimuli 136 maybe provided in the form of increased luminosity or brightness atlocations eccentric to the center of the image on the display.

The stimuli may be located in fixed locations or within a range of thecenter of the display 110. Such a fixed arrangement of stimuli withinthe display of a VR headset may provide stimulation in substantiallyfixed locations on the retina of a user because the display, the defocustreatment device, in the user's eyes are maintained in a substantiallyfixed arrangement by the mounting of the VR headset to the patient'shead. In some embodiments, the VR headset may include an eye trackerthat tracks the location and/or the orientation of the user's eye. Thestimuli and associated lenslets may be sized such that they are about0.5 to 5 degrees in apparent diameter in the field of view of a user,more preferably about 2 to 3 degrees, and most preferably about 2.3degrees.

The one or more stimuli may include images configured in many ways andmay include an image structure corresponding to information or contentassociated with spatial frequencies. In some embodiments, the stimulimay include a darker area within a brighter area or a brighter areawithin a darker area. For example, as shown in FIG. 7, the stimuli mayinclude a bright circular area with a dark cross shape inscribed within.The cross shape may include two dark lines intersecting perpendicular toeach other, for example, at their midpoints and at the center of thebright circle. In some embodiments, the stimuli may include a singleline extending across the diameter of the circle.

In the defocus treatment device 124, the stimuli 136 along with thevideo content projected by the display 110 are projected through theperipheral defocus optical structure 120 and accordingly both the imageof the video content and the stimuli 136 may be defocused by theperipheral defocus optical structure 120.

FIGS. 8 and 9 show a perspective and cross-section of defocus treatmentdevice 124, respectively, including the plano center area 118 and theperipheral defocus optical structure 120. The peripheral defocus opticalstructure 120 may include a plurality of lenslets 146 each having acurved surface shaped according to the desired diopter in defocus of thelenslets. The lenslets for may have other shapes or structures. Forexample, lenslets may be formed from one or more of a diffractiveoptical structures, GRIN lenses, echelettes, holographic lenses, orFresnel lenses having a shape or structure to create the desiredoptical. In some embodiments, the lenslets may be electrically tunablelenses that allow for dynamic variation in the defocus provided by thelenslets 146. For example, in some embodiments the lenslets may provideno defocus during certain periods while providing a defocus of 2 to 6 Dduring other periods.

The defocus treatment device 124 may include filter 130 such as aneutral density filter or mask layer 142. The layer 142 may include aneutral density filter in the areas of the lens that are desired to bedarker and have lower illumination. The neutral density filter may belocated on a posterior surface of the defocus treatment device 124opposite an anterior surface on which the peripheral defocus opticalstructure 120, such as the lenslets 146, is located. In someembodiments, the neutral density filter layer 142 may extend from theplano center 118 and to plano regions of the peripheral defocus opticalstructure 120 such that a portion of the light passing through the planoregions of the peripheral defocus optical structure 120 is filtered bythe neutral density filter layer 142. In some embodiments, the neutraldensity filter layer 142 may not cover locations of the defocustreatment device 124 corresponding to the locations of lenslets 146. Theperipheral stimuli 136 may be provided, at least in part, by one or morelocations on the defocus treatment device 124 not subject to filteringby the neutral density filter layer 142. Structures such as apertures ortransparent material may be formed in or through the neutral densityfilter layer 142 to allow unfiltered light to pass through. For example,as shown in the cross-section of FIG. 9, the defocus treatment device124 includes a neutral density filter layer 142 and stimuli locationswith structures formed to allow unfiltered light to pass through. Thestructures may be of a shape as discussed above such that they form abright circular area with or without a dark cross shape inscribedwithin.

The outer perimeter of the aperture formed though the filter 130 mayinclude a light barrier or baffle 152 that aids in preventing lightpassing through one aperture towards the associated lenslet fromentering or scattering through the filter into a different lenslet notassociated with the aperture. In some embodiments, the baffle or barriermay extend into or through the optical layer 142 to the lenslet on theanterior surface of the peripheral defocus optical structure 120.

With reference to FIGS. 8 to 10, the defocus treatment device 124 mayinclude a clear base 140 on a posterior side of the defocus treatmentdevice 124 the base 140 may include a lens interface surface 144 forcoupling the defocus treatment device 124 to a lens, such as lens 112.In some embodiments, the lens interface surface 144 may include anadhesive to further facilitate coupling the defocus treatment device 124to a lens or other structure. In some embodiments, the defocus treatmentdevice 124 may be formed directly on or in a lens. In such embodiments,the defocus treatment device 124 may not have a base 140 on an anteriorsurface or the base 140 may be the optical structure such as the lens112.

FIG. 11 depicts a defocus treatment device 124 with a hardware-baseddefocus structure provided by a plurality of lenslets 146 and stimuli136 provided by hardware and optionally by software, such as softwarethat modifies the image projected from a display to include stimuli. Thedefocus treatment device 124 includes a central optical zone 118, and aperipheral defocus optical structure 120. The central optical zone 118may be plano such that it has substantially planar surfaces or mayotherwise be shaped such that it provides little to no change in theangle of the incident light passing through the central optical zone118. The central optical zone 118 may also include a neutral densityfilter 130 or mask 150. The defocus treatment device 124 may have asubstantially plano anterior surface in non-stimuli areas, for examplein areas not including lenslets 146. The neutral density filter 130filters light passing through the plano regions of the defocus treatmentdevice 124. In some embodiments, the neutral density filter 130 filterslight passing through the defocus treatment device 124 in nonstimulatedregions of the defocus treatment device 124.

The peripheral area of the defocus treatment device 124 includes aperipheral defocus optical structure 120. The peripheral defocus opticalstructure 120 may include one or more lenses in the outer region of thedevice 124. For example, the peripheral defocus optical structure 124may include an array of lenslets 146 as shown in FIGS. 11 to 15. Theplurality of lenslets 146 may be shaped and arranged to providedefocused images to a peripheral portion of the retina while providingclear vision to the fovea and the macula when the user looks ahead.

The lenslets 146 of the peripheral defocus optical structure 120 may bearranged in one or more circular arrays centered about the centraloptical zone 118 of the defocus treatment device 124. The one or morecircular arrays may form an annular shape having an inner diameter andan outer diameter selected such that the peripheral defocus is appliedto a portion of the retina of the patient's eye that is eccentric to thefovea. For example, the inner diameter may be selected such that it isat an angle of about 7.5 degrees with respect to an optical axis of theoptic 112 and pupil. The outer diameter of the peripheral defocusoptical structure 120 may be at an outer boundary angle with respect tothe optical axis of the patient's eye and the pupil, for example at 17.5degrees. Such an arrangement results in the peripheral defocus opticalstructure 120 being located in a peripheral field of view of the userwith a corresponding defocus of the projected light in a peripheralregion of the user's retina eccentric to the fovea.

In some embodiments, the location of the lenslets 146 and the unfilteredareas of the defocus treatment device 124 may be positioned with respectto each other such that the light passing through the unfiltered areasof the device 124 also pass through the lenslets 146 such that theunfiltered light is defocused with respect to the patient's retina. Insome embodiments, the The defocus treatment device may be used incombination with localized stimuli in the peripheral zone to treatrefractive errors of the eye. The localized stimuli may be part of aprojected image, for example from a display, or may be provided bystructure within or a part of the defocus treatment device.

Stimuli 136, shown in FIGS. 7 and 11, include a lighter area within adarker area as described herein. The stimuli 136 includes a circulararea having an unfiltered cross shape inscribed within. The cross shapemay include two unfiltered lines intersecting perpendicular to eachother, for example, at their midpoints and at the center of the circle.The stimuli may also include wedge shaped neutral density filters 130 ormasks 150. Each wedge shaped neutral density filter or mask 150 may filla quadrant of the circular stimuli formed by the cross-shaped unfilteredareas. In some embodiments, the stimuli may filter light to the same,greater, or lesser extent as the neutral density filter 130 on thenon-stimuli areas of the defocus treatment device 124. For example, thestimuli 136 may further reduce light transmission as compared to theunfiltered areas of the stimuli by at least a factor of 5, preferably atleast a factor of 10, 20, or 30. In some embodiments, the lighttransition difference provided by the neutral density filter as comparedto non-filtered areas of the defocus treatment device 124 may be afactor of about 5, 10, 20, or 30. In some embodiments the illuminationdifference may be between a factor of 5 and 30, more preferably betweena factor of 10 and 20. In some embodiments, the stimuli 136 may notinclude a neutral density filter.

In some embodiments, the shaped mask 150 may provide the stimuli. Forexample, the stimuli of the mask 150 may include images configured inmany ways and may include an image structure corresponding toinformation or content associated with spatial frequencies. In someembodiments, the one or more images projected in the stimuli comprises aspatial frequency within a range from 0.1 cycle per degree to 180 cyclesper degree, and optionally a contrast within a range 99.9% to 2.5%, forexample. In some embodiments, the one or more images projected in thestimuli comprises a spatial frequency within a range from 1 cycle perdegree to 180 cycles per degree, and a contrast within a range 99.9% to2.5%, for example. In some embodiments, the projected image comprisesimage structure content configured to provide a range of spatialfrequencies, for example within a range from 2 cycles per degree toabout 60 cycles per degree. In some embodiments, the image is projectedonto the retina with a modulus of an optical transfer function that isequal to or better than 0.3 at a spatial frequency of 50 lp/mm orgreater. In some embodiments, the image projected onto the retinacomprises spatial frequencies of at least 1 line pair per mm (“lp/mm”)on the retina, or greater.

Referring again to FIGS. 3A and 3B, the display 110 may provide video orother image content for projection through the defocus treatment device124 and into the eye of a user. As discussed above, the defocustreatment device 124 may be placed on anterior to the optic 112, such asa lens of a virtual reality headset or eyeglasses or other devices wornby user. In the embodiments shown in FIG. 12 the video content or otherimagery provided by the display 110 may be modified to provide stimuli136. The stimuli 136 may be provided in the form of increased luminosityor brightness at locations eccentric to the center of the image on thedisplay.

In some embodiments, the stimuli and associated lenslets are sized suchthat they are about 0.5 to 5 degrees in apparent diameter in the fieldof view of a user, more preferably about 2 to 3 degrees, and mostpreferably about 2.3 degrees. In the embodiment shown in FIG. 12 thevideo content or other imagery provided by light from the display 110may be modified by the defocus treatment device 124 to provide thestimuli. The hardware stimuli can be provided with crosses, eitheralternatively to stimuli on the display or in combination with videostimuli on the display.

In the defocus treatment device 124, the video content provided by thedisplay 110 is projected through the lenslets 146 and the stimuli 136 ofthe mask 150 in the peripheral defocus optical structure 120 andaccordingly both the image of the video content and the stimuli 136 aredefocused by the peripheral defocus optical structure 120. In someembodiments, the display may include bright locations that align withthe stimuli 136 and the lenslets 146 of the peripheral defocus opticalstructure 120 to provide additional brightness and contrast to thestimuli as compared to the other regions of the defocus treatment device124.

FIGS. 13 and 14 show a perspective and cross-section of defocustreatment device 124, respectively, including the central optical zone118 comprising the plano center area 128 and the peripheral defocusoptical structure 120 and its associated lenslets 146 and masks 150. Theperipheral defocus optical structure 120 may include a plurality oflenslets 146 each having desired optical power to provide defocus withthe lenslets. The lenslets for may have other shapes or structures. Forexample, lenslets may be formed from a diffractive optical structure,echelettes, GRIN lenses, or Fresnel lenses having a shape or structureto create the desired diopter. In some embodiments, the lenslets may beelectrically tunable lenses that allow for dynamic variation in thedefocus provided by the lenslets 146. For example, in some embodimentsthe lenslets may provide no defocus during certain periods whileproviding a defocus of between 2 and 6 D during other periods.

The defocus treatment device 124 may include a neutral density filter130 or mask layer 148. The mask layer 148 may include a neutral densityfilter 130 in the areas of the lens that are desired to be darker andhave lower illumination. The neutral density filter may be located on aposterior surface of the defocus treatment device 124 opposite ananterior surface on which the peripheral defocus optical structure 120,such as the lenslets 146, is located. In some embodiments, the neutraldensity filter 130 may extend from the plano center 128 and planoregions to the peripheral defocus optical structure 120 such that aportion of the light passing through the plano regions of the peripheraldefocus optical structure 120 is filtered by the neutral density mass130. In some embodiments, the neutral density filter 130 may not coverlocations of the defocus treatment device 124 corresponding to thelocations of lenslets 146. The peripheral stimuli 136 may be provided,at least in part, by one or more locations on the defocus treatmentdevice 124 not subject to filtering by the neutral density filter 130.Structures may be formed in or through the neutral density filter 130 toallow unfiltered light to pass through. For example, as shown in thecross-section of FIG. 14, the defocus treatment device 124 includes aneutral density filter 130 and stimuli locations with structures formedto allow unfiltered light to pass through. The structures may be of ashape as discussed above such that they form a bright circular area withor without a light cross shape inscribed within.

The mask 150 that includes the stimuli may be an image or structureformed on the clear base 140 or within the wedge-shaped areas in theneutral density filter 130 at the location of corresponding lenslets146.

With reference to FIGS. 13-15, the defocus treatment device 124 mayinclude a clear base 140 on a posterior side of the defocus treatmentdevice 124 the base 140 may include a lens interface surface 144 forcoupling the defocus treatment device 124 to a lens, such as lens 112.In some embodiments, the lens interface surface 144 may include anadhesive to further facilitate coupling the defocus treatment device 124to a lens or other structure. In some embodiments, the defocus treatmentdevice 124 may be formed directly on or in a lens. In such embodiments,the defocus treatment device 124 may not have a base 140 on an anteriorsurface or the base 140 may be the optical structure such as the lens112.

FIG. 16 a spectacle 200 that incorporates a defocus treatment device 124with a hardware-based peripheral defocus optical structure 120 andstimuli provided by hardware, such as a mask, as discussed above withreference to mask 150. The defocus treatment device includes a centraloptical zone 118, and a peripheral defocus optical structure 120.

The peripheral defocus optical structure 120 may be implemented in manyways, such as any of the structures discussed herein, including aFresnel lens, lenslets, diffractive optics, or echelettes. The centraloptical zone 118 and non-stimulated regions of the peripheral defocusoptical structure may also include a neutral density filter or mask, asdiscussed herein. The defocus structure device may be incorporate intothe lens 112 of the spectacles or may be a separate structure that iscouplable to the lenses 120 or another portion of the spectacles, suchas the spectacle frame.

FIG. 17 shows a treatment apparatus comprising a device 124 coupled to adisplay 110 of a device such as a user device to provide retinalstimulation to the user. In some embodiments, the display 110 comprisesa protective layer 1720 and a pixel layer 1730. The plurality oflenslets 146 is spaced from the pixel layer 1730 by a distance 1710. Thedistance 1710 and the optical power of the lenslets can be configured tofocus the plurality of stimuli anterior or posterior to the retina withan appropriate amount of defocus.

In some embodiments, the base 140 and the layer 142 each comprises athickness dimensioned to place the plurality of lenslets 146 at thedistance 1710 from the pixel layer 1730. In some embodiments, thedefocus treatment device 124 comprises the clear base 140 to couple tothe display with the adhesive. The layer 142 may comprise a filter.Alternatively, the layer 142 may comprise a substantially clear layerand the display configured to provide a dark background around thestimuli, for example. In some embodiments, the layer 142 comprises athickness to place the lenslet array at an appropriate distance 1710from the pixel layer 1730. Alternatively or in combination, the clearbase 140 comprises a thickness to place the lenslet array at theappropriate distance 1710. Although base 140 and layer 142 are shown, insome embodiments, the lenslet array comprises a thickness dimensioned toposition the lenslets 146 at the distance 1710 from the pixels 1730without the base 140 and layer 142. For example, adhesive layer 1740 cancouple the lenses of the lenslet array 146 directly to the protectivelayer 1720 of the display 138 with the lenslets positioned at distance1710 from the pixel layer 1730.

In some embodiments, the device 124 is coupled to the display with anadhesive layer 1740. Alternatively, the device 124 can be placed in asupport such as a holder to place the lenslet array at distance 1710from the display. In some embodiments, the device 124 is provided to theuser with a peelable cover on the adhesive layer for the user to peelthe cover and place the device 124 on the display. Although reference ismade to layer 1740 comprising an adhesive layer, in some embodiments thelayer 1740 comprises a weak adhesive that allows the user to remove thedevice 124 from the display.

In some embodiments, the lenslets comprise an optical power and thedistance 1710 is dimensioned to provide appropriate magnification to thestimulus, so as to provide a suitable distance across each of theplurality of stimuli.

In some embodiments, a processor comprises instructions to provide theplurality of stimuli 136 on the display with appropriate sizes andlocations to provide retinal stimulation as described herein. A personof ordinary skill in the art of optics can determine the focal lengthsof the lenslets 146 and the distance 1710 between the lenslets and thepixel layer to provide appropriate angular sizing of the stimuli 136 onthe display as described herein, for example with reference to FIG. 3B.

In some embodiments, each of the plurality of lenslets is separated froman adjacent lenslet by a gap to decrease optical interference amongstimuli, such that each stimulus can be provided to a region of theretina substantially without light from neighboring stimuli. Forexample, the plurality of stimuli on the display can be separated fromeach other similarly to the spacing of the lenses of the lenslet array.The display may comprise a substantially dark background with gapsbetween the stimuli as shown in FIG. 3B. Alternatively, the layer 142may comprise an optically non-transmissive material that definesapertures or windows of transmissive material corresponding to locationsof the lenses, so as to decrease optical interference.

FIG. 18 shows a plurality of lenslets with a liquid crystal materialbetween electrodes. In some embodiments, the peripheral defocusstructure comprises the plurality of lenslets of a lenslet array 146,the electrodes and the liquid crystal (“LC”) material in order toactivate and deactivate the optical power of the lenslets. In the activeconfiguration, the lenslets comprise optical power to generate theplurality of stimuli. In the inactivate configuration, the optical powerof the lenslets is decreased, and appear substantially transparent tothe user, so that the user can view the display normally, e.g. throughthe substantially inactive lenslets.

In some embodiments, the peripheral defocus structure comprises a firstelectrode 1710 and a second electrode 1720, which are spaced apart withthe liquid crystal material 1730 and the lenslets 1740 between theplurality of substantially transparent electrodes. The liquid crystalmaterial and the plurality of lenslets are positioned between theplurality of electrodes to activate and deactivate optical power of theplurality of lenslets.

In some embodiments, the plurality of lenslets between the electrodescan be optically coupled to a display, and the processor of the mobiledevice is operatively coupled to the display. The processor comprisesinstructions to provide the plurality of stimuli on the display at aplurality of locations to form the images at a plurality of locationsanterior or posterior to the retina. In some embodiments, each of theplurality of stimuli on the display is aligned with a correspondinglenslet to form an image at a location anterior or posterior to aperipheral portion of the retina.

The electrodes, liquid crystal (“LC”) material and lenslets can beconfigured in many ways. In some embodiments, the lenslets comprise oneor more of diffractive optics, refractive optics, holographic optics, orechelettes. In some embodiments a potential difference (Voltage) isdelivered by a transparent electrode, e.g., Indium Tin Oxide (ITO). Theelectrode may comprise a thickness within a range from 20 nm to 200 nm.The metal may be deposited on an aligned layer of a substrate, such asan SiO2 layer, that has a thickness within a range from 5 nm to 30 nm.In some embodiments, alignment of the SiO2 layer is achieved by obliquedeposition. In some embodiments, the alignment of the SiO2 layer drivesalignment of the LC molecules at a lower voltage.

While the coating thickness can be configured in many ways, in someembodiments the thickness is determined with optimization. For example,simulations can be performed to optimize the transmission with ITO-SiO2coatings. For ITO-SiO2 layers on glass substrate, work in relation tothe present disclosure suggests that a thicknesses of 20 nm and 230 nm,respectively, can provide maximum transmission for light at 550 nm atnormal incidence. While the transmission can be any suitable amount,e.g. 80% or more, the calculated transmission can be approximately93.35% at normal incidence for an air/ITO interface, for example.Although reference is made to SiO2 (glass) as a substrate materialhaving an index of refraction of 1.67, the substrate material maycomprise any suitable material, such as glass or plastic, for example.

In some embodiments, the liquid crystal material comprises asubstantially transparent material with a glass transition temperaturebelow −10 degrees C. and a melting point above 100 degrees C. The liquidcrystal material may comprise one or more of a nematic phase, acholesteric phase or smectic phase. The liquid crystal material maycomprise a cholesteric liquid crystal with a dichroic dye. The dichroicdye may have an orientation dependent absorption of light or it may havean orientation dependent average refractive index. Both such propertiesof dichroic dyes may be used in construction of the electroactiveelement disclosed herein.

In some embodiments, the liquid crystal material comprises asubstantially transparent material with a glass transition temperaturebelow −10 degrees C. and a melting point above 100 degrees C. The liquidcrystal material may comprise one or more of a nematic phase, acholesteric phase or smectic phase. The liquid crystal material maycomprise a cholesteric liquid crystal with a dichroic dye. The dichroicdye may have an orientation dependent absorption of light or it may havean orientation dependent average refractive index. Both such propertiesof dichroic dyes may be used in construction of the electroactiveelement disclosed herein.

The electroactive component can be configured in many ways. For example,the electroactive component may comprise an assembly configured forplacement on the lens at a suitable time during manufacture of the lens.For example, the component may comprise a stand-alone componentconfigured for placement on the lens, either before or after the curvedrefractive surface has been ground on the lens. The circuitry can becoupled to the electroactive component with suitable connectors andmounted on the support such as an eyeglass frame at a suitable locationas described herein.

Table 1 shows liquid crystal formulations commercially available fromMerck and their material properties such as refractive indices.

TABLE 1 diel. Viscosity, LC n_(e) n_(o) Birefringence n_(avg) T_(C), °C. anisotropy mPa · s MDA-98-1602/PO 1.7779 1.5113 0.2666 1.6446 10911.9 203 MLC-2134 1.7691 1.5106 0.2585 1.63985 112 — — MLC-2132 1.76571.5094 0.2563 1.63755 114 10.7 MLC-6080 1.71 1.5076 0.2024 1.6088 95 7.2 157 MLC-2136 1.7162 1.5038 0.2124 1.61 92  7.1 134 BL 006 1.8161.53 0.286 1.673 113 17.3 71 DIC/PHC 1.765 1.514 0.251 1.6395 99.4 16.243.1 E7 1.7394 1.5224 0.217 1.6309 61 13.2 — E44 1.7859 1.52778 0.258121.65684 — — — MDA-05-2986 1.781 1.5125 0.2685 1.64675 — — —

Although reference is made to specific liquid crystal materials, one ofordinary skill in the art will recognize that many adaptations andvariations can be made.

A person of ordinary skill in the art can identify lenslet materialssuitable for use with the LC material provide appropriate switching ofthe optical power of the lenslet array. While many materials can beused, examples of lenslet materials include one or more of ion dopedglasses, polyacrylates, polymethacrylates, polyaromatics, polysulfones,polyimides, polyamides, polyethers, polyether ketones, or polycyclicolefins.

In some embodiments, the liquid crystal material is switchable from afirst refractive index in the first configuration to substantiallyrefract light with the lenslet array to a second refractive index in asecond configuration to substantially transparently transmit lightwithout substantial optical power from the lenslet array. The secondrefractive index is closer to a refractive index of the lenslet array todecrease optical power from the lenslet array in the secondconfiguration.

In some embodiments, the first refractive index differs from therefractive index of the lenslet array by at least 0.05 to providesubstantial optical power to the lenslet array and the second refractiveindex differs from the refractive index of the lenslet array by no morethan 0.02 to provide substantially decrease optical power andsubstantially transparently transmit light through the lenslet array,such that the presence of the lenslet array is not perceptible to theuser.

In some embodiments, the liquid crystal material is configured toprovide a change in refractive index within a range from 0.10 to 0.25.

FIG. 19 shows a treatment apparatus 100 comprising a display 110 coupledto a lenslet array 146 of a treatment device 124 as described herein.The apparatus 100 can be configured in many ways, and may comprise auser device comprising one or more of an ophthalmic device, a TV screen,a computer screen, a VR display, an AR display, a handheld, a mobilecomputing device, a tablet computing device, a smart phone, a wearabledevice, a spectacle lens frame, a spectacle lens, a near eye display, ahead-mounted display, a goggle, a contact lens, an implantable device, acorneal onlay, a corneal inlay, a corneal prosthesis, or an intraocularlens. In some embodiments, the treatment device comprises a user device,such as a smart phone or tablet, for example. The display of the userdevice can be configured to provide a plurality of stimuli 136 asdescribed herein. In some embodiments, the user device comprises lensletarray 146 placed over the plurality of stimuli, so as to provide animage of the stimuli anterior or posterior to the retina. In someembodiments, each lenslet of the lenslet array is aligned with one ofthe plurality of stimuli. The user device may comprise a zone 118 with aclear viewing area as described herein, for example without the lensletarray extending into the clear viewing area. The clear viewing area canbe configured for the user to view images, such as videos and allow theuser to use the device in a substantially normal manner, for example soas to use a web browser, play video games, send and receive texts andemails, etc. The lenslet array can be positioned at a distance from thepixels so as to provide an appropriate amount of defocus as describedherein.

As described herein, the computing devices and systems described and/orillustrated herein broadly represent any type or form of computingdevice or system capable of executing computer-readable instructions,such as those contained within the modules described herein. In theirmost basic configuration, these computing device(s) may each comprise atleast one memory device and at least one physical processor.

The term “memory” or “memory device,” as used herein, generallyrepresents any type or form of volatile or non-volatile storage deviceor medium capable of storing data and/or computer-readable instructions.In one example, a memory device may store, load, and/or maintain one ormore of the modules described herein. Examples of memory devicescomprise, without limitation, Random Access Memory (RAM), Read OnlyMemory (ROM), flash memory, Hard Disk Drives (HDDs), Solid-State Drives(SSDs), optical disk drives, caches, variations or combinations of oneor more of the same, or any other suitable storage memory.

In addition, the term “processor” or “physical processor,” as usedherein, generally refers to any type or form of hardware-implementedprocessing unit capable of interpreting and/or executingcomputer-readable instructions. In one example, a physical processor mayaccess and/or modify one or more modules stored in the above-describedmemory device. Examples of physical processors comprise, withoutlimitation, microprocessors, microcontrollers, Central Processing Units(CPUs), Field-Programmable Gate Arrays (FPGAs) that implement softcoreprocessors, Application-Specific Integrated Circuits (ASICs), portionsof one or more of the same, variations or combinations of one or more ofthe same, or any other suitable physical processor. The processor maycomprise a distributed processor system, e.g. running parallelprocessors, or a remote processor such as a server, and combinationsthereof.

Although illustrated as separate elements, the method steps describedand/or illustrated herein may represent portions of a singleapplication. In addition, in some embodiments one or more of these stepsmay represent or correspond to one or more software applications orprograms that, when executed by a computing device, may cause thecomputing device to perform one or more tasks, such as the method step.

In addition, one or more of the devices described herein may transformdata, physical devices, and/or representations of physical devices fromone form to another. Additionally or alternatively, one or more of themodules recited herein may transform a processor, volatile memory,non-volatile memory, and/or any other portion of a physical computingdevice from one form of computing device to another form of computingdevice by executing on the computing device, storing data on thecomputing device, and/or otherwise interacting with the computingdevice.

The term “computer-readable medium,” as used herein, generally refers toany form of device, carrier, or medium capable of storing or carryingcomputer-readable instructions. Examples of computer-readable mediacomprise, without limitation, transmission-type media, such as carrierwaves, and non-transitory-type media, such as magnetic-storage media(e.g., hard disk drives, tape drives, and floppy disks), optical-storagemedia (e.g., Compact Disks (CDs), Digital Video Disks (DVDs), andBLU-RAY disks), electronic-storage media (e.g., solid-state drives andflash media), and other distribution systems.

A person of ordinary skill in the art will recognize that any process ormethod disclosed herein can be modified in many ways. The processparameters and sequence of the steps described and/or illustrated hereinare given by way of example only and can be varied as desired. Forexample, while the steps illustrated and/or described herein may beshown or discussed in a particular order, these steps do not necessarilyneed to be performed in the order illustrated or discussed.

The various exemplary methods described and/or illustrated herein mayalso omit one or more of the steps described or illustrated herein orcomprise additional steps in addition to those disclosed. Further, astep of any method as disclosed herein can be combined with any one ormore steps of any other method as disclosed herein.

The processor as described herein can be configured to perform one ormore steps of any method disclosed herein. Alternatively or incombination, the processor can be configured to combine one or moresteps of one or more methods as disclosed herein.

Unless otherwise noted, the terms “connected to” and “coupled to” (andtheir derivatives), as used in the specification and claims, are to beconstrued as permitting both direct and indirect (i.e., via otherelements or components) connection. In addition, the terms “a” or “an,”as used in the specification and claims, are to be construed as meaning“at least one of” Finally, for ease of use, the terms “including” and“having” (and their derivatives), as used in the specification andclaims, are interchangeable with and shall have the same meaning as theword “comprising.

The processor as disclosed herein can be configured with instructions toperform any one or more steps of any method as disclosed herein.

It will be understood that although the terms “first,” “second,”“third”, etc. may be used herein to describe various layers, elements,components, regions or sections without referring to any particularorder or sequence of events. These terms are merely used to distinguishone layer, element, component, region or section from another layer,element, component, region or section. A first layer, element,component, region or section as described herein could be referred to asa second layer, element, component, region or section without departingfrom the teachings of the present disclosure.

As used herein, the term “or” is used inclusively to refer items in thealternative and in combination.

As used herein, characters such as numerals refer to like elements.

A generally accepted unit of optical power is the Diopter (“D”), whichis related to the inverse of the focal length of a lens in meters. Insome embodiments, a defocus optical structure comprises optical power toalter the focus of light with respect to the retina. A defocus opticalstructure may comprise positive optical power to form an image of astimulus anterior to the retina, or negative optical power to form theimage of the stimulus posterior to the retina. In some embodiments,myopic defocus corresponds to positive optical power, which can beexpressed with positive values in Diopters, and that hyperopic defocuscorresponds to negative optical power, which can be expressed innegative values in Diopters.

The present disclosure includes the following numbered clauses.

Clause 1. An apparatus to treat refractive error of an eye, theapparatus comprising: an optic comprising an optical zone; and aperipheral defocus optical structure to form images of a plurality ofstimuli anterior or posterior to a peripheral portion of a retina of theeye, the peripheral defocus optical structure located outside theoptical zone.

Clause 2. The apparatus of clause 1, wherein the peripheral defocusoptical structure comprises optical power to focus light to a differentdepth of the eye than the optical zone.

Clause 3. The apparatus of clause 1, wherein the optic comprises one ormore of a lens, an optically transparent substrate, a beam splitter, aprism, or an optically transmissive support.

Clause 4. The apparatus of clause 1, wherein peripheral defocus opticalstructure comprises a Fresnel lens.

Clause 5. The apparatus of clause 1, wherein peripheral defocus opticalstructure comprises a plurality of lenslets.

Clause 6. The apparatus of clause 5, wherein a plurality of lenslets isarranged in one or more circular arrays about the optical zone.

Clause 7. The apparatus of clause 1, wherein peripheral defocus opticalstructure comprises one or more of a diffractive optical structure orechelettes.

Clause 8. The apparatus of clause 1, further comprising a filter withinthe optical zone to decrease light transmission therethrough.

Clause 9. The apparatus of clause 8, wherein the filter is configured todecrease an intensity of a central image formed on a fovea of the eyeand provide an increased intensity of the plurality of stimuli inrelation to the intensity of the central image.

Clause 10. The apparatus of clause 8, wherein the filter extends intothe peripheral defocus optical structure.

Clause 11. The apparatus of clause 8, wherein the filter comprises aneutral density filter.

Clause 12. The apparatus of clause 8, wherein the filter reducestransmission of visible light by a factor of between 5 and 30.

Clause 13. The apparatus of clause 8, wherein the filter reducestransmission of visible light by an amount within a range from 5 percentto 99 percent.

Clause 14. The apparatus of clause 1, further comprising a display thatis configured to provide light through the optical zone to form acentral image on a macula and through the peripheral defocus opticalstructure to provide the plurality of stimuli with defocus on theperipheral portion of the retina.

Clause 15. The apparatus as in clause 14, wherein plurality of stimuliis formed with lenslets of the peripheral defocus optical structure.

Clause 16. The apparatus of clause 1, wherein the peripheral defocusoptical structure further comprises a plurality of stimuli generatingstructures.

Clause 17. The apparatus of clause 16, further comprising a filteraligned with one or more apertures of the peripheral defocus opticalstructure.

Clause 18. The apparatus of clause 17, wherein the plurality of stimuligenerating structures are within the aperture.

Clause 19. The apparatus of clause 18, wherein each of the plurality ofstimuli generating structures comprise a mask.

Clause 20. The apparatus of clause 1, wherein the each of the pluralityof stimuli comprises spatial frequencies.

Clause 21. The apparatus of clause 20, wherein the spatial frequenciescomprise frequencies within a range from 0.1 cycles per degree to 180cycles per degree and optionally within a range from 1 cycle per degreeto 180 cycles per degree.

Clause 22. The apparatus of clause 20, wherein the spatial frequenciescomprise frequencies of at least 1 line pair per mm (lp/mm) on theretina and optionally at least 50 lp/mm on the retina.

Clause 23. The apparatus of clause 1, wherein the plurality of stimulicomprise contrast within a range 99.9% to 2.5%.

Clause 24. The apparatus of clause 1, wherein the peripheral defocusoptical structure comprises an optical power within a range from −2 D to−6 D or within a range from +2D to +6D.

Clause 25. The apparatus of clause 1, wherein the peripheral defocusoptical structure comprises an optical power within a range from −3 D to−5 D or within a range from +3 D to +5 D.

Clause 26. The apparatus of clause 1, further comprising a base, whereinthe peripheral defocus optical structure is coupled to the base.

Clause 27. The apparatus of clause 26, further comprising adhesive on asurface of the base.

Clause 28. The apparatus of clause 27, wherein the optic comprises aspectacle lens and a filter and peripheral defocus optical structure arecoupled to the lens.

Clause 29. The apparatus of clause 1, wherein the optic comprises anadhesive.

Clause 30. The apparatus of clause 1, wherein the optic comprises aplurality of layers.

Clause 31. The apparatus of clause 1, further comprising: a display; anda processor operatively coupled to the display, wherein the processorcomprises instructions to provide the plurality of stimuli on thedisplay at a plurality of locations to form the images at a plurality oflocations anterior or posterior to the retina.

Clause 32. The apparatus of clause 31, wherein the peripheral defocusstructure comprises a plurality of lenslets, and wherein the each of theplurality of stimuli on the display is aligned with a correspondinglenslet to form an image at a location anterior or posterior to aperipheral portion of the retina.

Clause 33. The apparatus of clause 32, further comprising: a pluralityof substantially transparent electrodes; and a liquid crystal materialbetween the plurality of substantially transparent electrodes; whereinthe liquid crystal material and the plurality of lenslets are positionedbetween the plurality of electrodes to activate and deactivate opticalpower of the plurality of lenslets.

Clause 34. The apparatus of clause 33, wherein the plurality of lensletsis substantially transparent in a deactivated configuration and whereinthe plurality of lenslets is configured to provide the plurality ofstimuli in a deactivated configuration.

Clause 35. The apparatus of clause 33, wherein the plurality ofelectrodes is configured to change an index of refraction of the liquidcrystal material in response to a voltage between the electrodes.

Clause 36. The apparatus of clause 33, wherein the processor isoperatively coupled to the plurality of electrodes to activate theplurality of lenslets to provide the plurality of stimuli.

Embodiments of the present disclosure have been shown and described asset forth herein and are provided by way of example only. One ofordinary skill in the art will recognize numerous adaptations, changes,variations and substitutions without departing from the scope of thepresent disclosure. Several alternatives and combinations of theembodiments disclosed herein may be utilized without departing from thescope of the present disclosure and the inventions disclosed herein.Therefore, the scope of the presently disclosed inventions shall bedefined solely by the scope of the appended claims and the equivalentsthereof

What is claimed is:
 1. An apparatus to treat refractive error of an eye,the apparatus comprising: an optic comprising an optical zone; and aperipheral defocus optical structure to form images of a plurality ofstimuli anterior or posterior to a peripheral portion of a retina of theeye, the peripheral defocus optical structure located outside theoptical zone.
 2. The apparatus of claim 1, further comprising: aplurality of substantially transparent electrodes; and a liquid crystalmaterial between the plurality of substantially transparent electrodes;wherein the liquid crystal material and the peripheral defocus opticalstructure are positioned between the plurality of electrodes to activateand deactivate optical power of the peripheral defocus opticalstructure.
 3. The apparatus of claim 1, wherein the peripheral defocusoptical structure comprises optical power to focus light to a differentdepth of the eye than the optical zone.
 4. The apparatus of claim 1,wherein the optic comprises one or more of a lens, an opticallytransparent substrate, a beam splitter, a prism, or an opticallytransmissive support.
 5. The apparatus of claim 1, wherein peripheraldefocus optical structure comprises a Fresnel lens.
 6. The apparatus ofclaim 1, wherein peripheral defocus optical structure comprises one ormore of a diffractive optical structure or echelettes.
 7. The apparatusof claim 1, further comprising a filter within the optical zone todecrease light transmission therethrough.
 8. The apparatus of claim 7,wherein the filter is configured to decrease an intensity of a centralimage formed on a fovea of the eye and provide an increased intensity ofthe plurality of stimuli in relation to the intensity of the centralimage.
 9. The apparatus of claim 7, wherein the filter extends into theperipheral defocus optical structure.
 10. The apparatus of claim 7,wherein the filter comprises a neutral density filter.
 11. The apparatusof claim 7, wherein the filter reduces transmission of visible light bya factor of between 5 and
 30. 12. The apparatus of claim 7, wherein thefilter reduces transmission of visible light by an amount within a rangefrom 5 percent to 99 percent.
 13. The apparatus of claim 1, furthercomprising a display that is configured to provide light through theoptical zone to form a central image on a macula and through theperipheral defocus optical structure to provide the plurality of stimuliwith defocus on the peripheral portion of the retina.
 14. The apparatusof claim 1, further comprising a base, wherein the peripheral defocusoptical structure is coupled to the base.
 15. The apparatus of claim 14,further comprising adhesive on a surface of the base.
 16. The apparatusof claim 15, wherein the optic comprises a spectacle lens, and a filterand the peripheral defocus optical structure are coupled to thespectacle lens.
 17. The apparatus of claim 1, further comprising: adisplay; and a processor operatively coupled to the display, wherein theprocessor comprises instructions to provide the plurality of stimuli ata plurality of locations on the display to form the images at aplurality of locations anterior or posterior to the retina.
 18. Theapparatus of claim 17, wherein the peripheral defocus optical structurecomprises a plurality of peripheral defocus optical structures, andwherein the each of the plurality of stimuli on the display is alignedwith a corresponding peripheral defocus optical structure of theplurality of peripheral defocus optical structures to form an image at alocation anterior or posterior to the peripheral portion of the retina.19. The apparatus of claim 18, wherein the processor is operativelycoupled to the plurality of electrodes to activate the peripheraldefocus optical structure to provide the plurality of stimuli.
 20. Theapparatus of claim 19, further comprising: a base, the peripheraldefocus optical structure coupled to the base; and an adhesive on asurface of the base to couple the peripheral defocus optical structureto the display.